MRI detection of early blood-brain barrier disruption: parenchymal enhancement predicts focal hemorrhagic transformation after thrombolysis

Stroke. 2008 Mar;39(3):1025-8. doi: 10.1161/STROKEAHA.107.497719. Epub 2008 Feb 7.

Abstract

Background and purpose: Blood-brain barrier disruption may be a predictor of hemorrhagic transformation (HT) in ischemic stroke. We hypothesize that parenchymal enhancement (PE) on postcontrast T1-weighted MRI predicts and localizes subsequent HT.

Methods: In a prospective study, 33 tPA-treated stroke patients were imaged by perfusion-weighted imaging, T1 and FLAIR before thrombolytic therapy and after 2 and 24 hours.

Results: Postcontrast T1 PE was found in 5 of 32 patients (16%) 2 hours post-thrombolysis. All 5 patients subsequently showed HT compared to 11 of 26 patients without PE (P=0.043, specificity 100%, sensitivity 31%), with exact anatomic colocation of PE and HT. Enhancement of cerebrospinal fluid on FLAIR was found in 4 other patients, 1 of which developed HT. Local reperfusion was found in 4 of 5 patients with PE, whereas reperfusion was found in all cases of cerebrospinal fluid hyperintensity.

Conclusions: PE detected 2 hours after thrombolytic therapy predicts HT with high specificity. Contrast-enhanced MRI may provide a tool for studying HT and targeting future therapies to reduce risk of hemorrhagic complications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood-Brain Barrier*
  • Brain Ischemia / complications*
  • Cerebral Hemorrhage / chemically induced*
  • Humans
  • Magnetic Resonance Imaging*
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Sensitivity and Specificity
  • Stroke / diagnosis*
  • Stroke / drug therapy
  • Stroke / etiology
  • Stroke / physiopathology*
  • Thrombolytic Therapy / adverse effects*